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Meta-Analysis
. 2025 Feb 1;179(2):145-154.
doi: 10.1001/jamapediatrics.2024.5998.

Occurrence and Time of Onset of Intraventricular Hemorrhage in Preterm Neonates: A Systematic Review and Meta-Analysis of Individual Patient Data

Zsuzsanna Nagy  1   2   3 , Mahmoud Obeidat  1 , Vanda Máté  1   4 , Rita Nagy  1   5   6 , Emese Szántó  2   3 , Dániel Sándor Veres  1   7 , Tamás Kói  1   8 , Péter Hegyi  1   6   9 , Gréta Szilvia Major  1 , Miklós Garami  1   4 , Ákos Gasparics  1   2   3 , Arjan B Te Pas  10 , Miklós Szabó  1   3   4
Affiliations
Meta-Analysis

Occurrence and Time of Onset of Intraventricular Hemorrhage in Preterm Neonates: A Systematic Review and Meta-Analysis of Individual Patient Data

Zsuzsanna Nagy et al. JAMA Pediatr. .

Abstract

Importance: Intraventricular hemorrhage (IVH) has been described to typically occur during the early hours of life (HOL); however, the exact time of onset is still unknown.

Objective: To investigate the temporal distribution of IVH reported in very preterm neonates.

Data sources: PubMed, Embase, Cochrane Library, and Web of Science were searched on May 9, 2024.

Study selection: Articles were selected in which at least 2 cranial ultrasonographic examinations were performed in the first week of life to diagnose IVH. Studies with only outborn preterm neonates were excluded.

Data extraction and synthesis: Data were extracted independently by 3 reviewers. A random-effects model was applied. This study is reported following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. The Quality in Prognostic Studies 2 tool was used to assess the risk of bias.

Main outcomes and measures: The overall occurrence of any grade IVH and severe IVH among preterm infants was calculated along with a 95% CI. The temporal distribution of the onset of IVH was analyzed by pooling the time windows 0 to 6, 0 to 12, 0 to 24, 0 to 48, and 0 to 72 HOL. A subgroup analysis was conducted using studies published before and after 2007 to allow comparison with the results of a previous meta-analysis.

Results: A total of 21 567 records were identified, of which 64 studies and data from 9633 preterm infants were eligible. The overall rate of IVH did not decrease significantly before vs after 2007 (36%; 95% CI, 30%-42% vs 31%; 95% CI, 25%-36%), nor did severe IVH (10%; 95% CI, 7%-13% vs 11%; 95% CI, 8%-14%). The proportion of very early IVH (up to 6 HOL) after 2007 was 9% (95% CI, 3%-23%), which was 4 times lower than before 2007 (35%; 95% CI, 24%-48%). IVH up to 24 HOL before and after 2007 was 44% (95% CI, 31%-58%) and 25% (95% CI, 15%-39%) and up to 48 HOL was 82% (95% CI, 65%-92%) and 50% (95% CI, 34%-66%), respectively.

Conclusion and relevance: This systematic review and meta-analysis found that the overall prevalence of IVH in preterm infants has not changed significantly since 2007, but studies after 2007 showed a later onset as compared with earlier studies, with only a small proportion of IVHs occurring before 6 HOL.

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Conflict of interest statement

Conflict of Interest Disclosures: None reported.

Figures

Figure 1.
Figure 1.. Flowchart of the Screening and Selection Process of the Studies
Figure 2.
Figure 2.. Overall Intraventricular Hemorrhage (IVH) Occurrence in Preterm Infants Before and After 2007
Diamonds indicate overall proportions.
Figure 3.
Figure 3.. Overall Severe Intraventricular Hemorrhage (IVH) Occurrence in Preterm Infants Before and After 2007
Diamonds indicate overall proportions. aAbstract presented at the 73rd Annual Congress of the Japan Society of Obstetrics and Gynecology.
Figure 4.
Figure 4.. Intraventricular Hemorrhage (IVH) Rate Among All Preterm Infants by Postnatal Age
aP < .05.
Figure 5.
Figure 5.. IVH Rate Among All Intraventricular Hemorrhage (IVH) Events by Postnatal Age
aP < .01.
See this image and copyright information in PMC

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